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RADT Lower Limb

CH.6 Merrills Lower limb

What is the position of part for the Lateral Femur (with the knee included)?

Distal Femur- draw the patient's uppermost limb forward, true lateral position, and adjust the position of the Bucky tray so that the IR projects approximately 2 inches beyond the knee to be included.

What is the position of part for the Lateral Femur (with the hip included)?

For the proximal femur, place the top of the IR at the level of the ASIS. Adjust the pelvis so that it is rolled 10 to 15 degrees from the lateral position to prevent superimposition.

What is the central ray for the Lateral Femur?

Perpendicular to the midfemur and the center of the IR

What is the structures shown for the Lateral Femur?

The lateral projection of 3/4ths of the femur and adjacent joint. If needed, use two IRs for the entire adult femur.

What is the evaluation criteria for the Lateral Femur?

A 2nd radiograph for the other end of femur is recommended,Any orthopedic,Trabecular detail on the femoral body, With the knee- Superimposed anterior surface of the femoral condyles, Patella in profile, opposite thigh, greater trochanter not prominent.

Added evaluation criteria for the Lateral Femur?

Patients with the conditions should be examined in the supine position by placing the IR vertically along the medial or lateral aspect of the thigh and knee and the directing the central ray horizontally.

Position of patient for the AP Femur?

Supine, pelvis is not rotated

Position of part for the AP Femur?

Center the IR midline, when patient is too tall include the entire femur, include the joint closest to the area of interest.

Position of part for the AP Femur (with hip included)?

Proximal femur-which must include the hip joint, place the top of the IR a the level of the ASIS. Rotate limb internally 10to15 degrees to place the femoral neck in profile.

Structures shown and evaluation criteria for the AP femur?

Projection of the femur, including the knee joint and/or the hip. Femoral neck not foreshortened on the proximal femur.

What is the position of the patient for the Tangential Projection(Settegast Method)?

Supine or Prone. Use an even, slow flexion to tolerate pain. Place IR transversely under the knee and center to joint space b/t the patella and the femoral condyles.

What is the central ray for the Tangential Projection for the Patella?

Perpendicular to the joint space between the patella and the femoral condyles when joint is perp. The angulation is 15-20degress when space is not perp.

What is the evaluation criteria for the Tangential Settegast?

Patella in profile, open patellofemoral artic., Surfaces of the femoral condyles, soft tissue, and bony detail of patella and femoral condyles

What is the SID for Tangential Projection Merchant Method?

6 feet, to reduce magnification

What is the position of part for Tangential Projection (Merchant Method)?

Adjust the angle of knee flexion to 40 degrees, may varies 30to90 to demonstrate patellofemoral disorders, Place IR perpendicular to the central ray 1 ft distal to patellae,

What is the structure shown for a Tangential projection(Merchant Method)?

The right angle alignment of the IR and the central ray, the patellae are seen as nondistorded, albeit slightly magnified images.

What is the evaluation criteria for the Tangential projection(Merchant Method)?

Center the IR to the Patella, Adjust the leg to place patella parallel with IR, usually requires that the heel be rotated 5-10 degrees laterally.

What is the CR for the PA Patella?

Perpendicular to the midpopliteral area exiting the Patella, Collimate close to the patellar area.

What is the structures shown for the PA Patella?

The PA projection of the patella provides sharper recorded detail than in the AP projection because of the close object to image receptor distance.

What is the position of patient in the PA Axial (Camp-Coventry) for the Intercondylar Fossa?

Place the patient in prone, and do not rotate.

Position of Part for the Camp-Coventry?

Flex the knee to either 40-50 and rest foot on support, Center the upper half of the IR to the knee joint the central ray angulation projects the joint to the center of the IR. Adjust leg so knee has no medial or lateral rotation.

CR for the Camp-Conventry?

Perpendicular to the long axis of the lower leg and centered to the knee joint. Angled 40 degrees when the knee is flexed 40 degrees and 50 degrees when the knee is flexed 50 degrees.

Structures shown for the Camp-Coventry?

Axial image shows unobstructed projection of the intercondyloid fossa and the medial and lateral intercondylar tubercles of the intercondylar eminence.

What are the four parts of the lower limb?

1. Hip2. Leg3. Thigh4. Hip

How many bones are in the foot?

26 Bones Total14 Phalanges5 Metatarsals7 Tarsals

What are the Forefoot, Midfoot, and Hindfoot and what do they contain?

Forefoot- The metatarsals and toesMidfoot- Five tarsals, cuneiforms, navicular, and cuboidHindfoot- Talus and Calcaneus

What is the largest and strongest tarsal bone?

Calcaneus

What does the talus articulates with?

Tibia, Fibula, Calcaneus, and Navicular

What does the Trochlear surface articulate with?

Tibia and connects with the foot to the leg.

Where is the cuboid bone located?

The cuboid bone lies on the lateral side of the foot between the calcaneus and the fourth and fifth metatarsals.

Where is the navicular bone located?

The navicular bone lies on the medial side of the foot between the talus and the three cuneiforms.

What does the leg contain?

Tibia and Fibula

What is the sharp projection between the two surfaces of the the tibal plateaus?

The intercondylar eminence

Whar is the distal end of the tibia and its medial surface is prolonged into a large process?

Medial malleolus

What is the apex?

The apex is the lateorposterior aspect of the head that is the conic projection

The patella is the largest and most constant sesamoid bone in the body. That is flat, triangular anterior surface of the femur

Where is the apex located?

Directed inferiorly lies 1/2 inch above the knee joint

What are the three positions for the Intercondylar Fossa PA Axial (Holmblad Method)?

1. Standing w/knee of interest in flexed & resting on a stool at the side of the table 2. Standing at side of table w/affected knee flexed & placed in contact w/IR. 3. Kneeling on table w/affected knee over IR. (Patient leans over table for support)

What is the position of part for the Intercondylar Fossa PA Axial (Holmblad Method)?

Flex knee 70 from full extension (20 difference from the CR)

What is the Positon of part for the AP Oblique Knee (Medial)?

Medially rotated the limb, ate elevate the hip of the affected side enough to rotate the limb 45.

What is the Central Ray for AP Oblique Knee both Lateral and Medial Rotation?

If necessary, elevate the hip of the unaffected side enough to rotate the affected limb. Center IR 1/2 below the apex of the patella. Externally rotate the limb 45 degrees

What is the Central Ray for the AP Weight Bearing Knees?

Ask the patient to stand straight w/knees fully extended. Center the IR 1/2 below the apices of the patellae.

What is the position of part for the Knee Lateral?

A flexion of 20-30 is usually preferred bc this position relaxes the muscles & shows the max. volume of the joint cavity. To prevent fragment separation in new or unhealed patellar fractures, the knee should not be flexed more than 10.

What is the Central Ray for the Knee Lateral?

Directed to the knee joint 1in distal to the medial epicondyles at an angle of 5-7 cephalad.

What is the Central Ray for the PA Knee?

Directed at an angle of 5-7 caudad to exit a point 1/2 inferior to the patellar apex. B/C the tib/fib are slightly inclined, the CR will be parallel w/the tibial plateau

What is the position of part for the AP Oblique Leg?

Rotate the limb 45 degress medially or laterally. For the medial rotation ensure that the leg is turned inward and not just the foot.

What is the position of part for the Lateral Leg?

Adjust rotation of the body to place the patella perpendicular to IR and ensure that a line drawn thru the femoral condyles are perpendicular. ALT: When pt cannot be turned from supine position, the lateral projection may be taken cross-table.

What is the position of part for the Ankle AP Oblique?

Place plantar surface of foot in vertical position & laterally rotate leg and foot 45 degrees.

What is the position of part for the Ankle Mortise Joint (AP Oblique)?

Grasp diatal femur area w/one hand and foot w/the other. Assist pt by internally rotating the entire leg and foot together 15-20 degrees until the intermalleolar plane is parallel w/IR.